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| 1. How much pain or discomfort are you experiencing now? |
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| 2. How would you rate your stress level right now? |
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| 3. To what extend does stress have a negative impact on your daily activities? |
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| 4. Do you feel isolated or alone? |
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| POST-SESSION: Please complete this section AFTER class (select one). |
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| 5. To what extend do you feel physical pain or discomfort at this time? |
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| 6. How would you rate your stress level right now? |
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| 7. To what extend do you now feel relaxed? |
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| 8. Do you feel isolated or alone? |
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